Medical barriers to access to family planning.
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Allied Health Personnel↗
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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Chemical mixtures released from hazardous waste sites: implications for health risk assessment.
Uncontrolled hazardous waste sites (HWS) and exposure to hazardous substances continue to pose complex public health problems. This paper presents an overview of chemicals, including chemical mixtures, that have been released into environmental media in the vicinity of HWS. We describe how this type of information is being used to assess the public health implications of exposures to chemical mixtures and to develop an integrated program of applied research to more accurately characterize the potential health effects of chemical mixtures. A narrative, weight-of-evidence approach, incorporating mechanistic insights on chemical interactions is described. The utility of this information in the context of risk analysis and public health practice is discussed.
Animals↗
Objectives to direct the training of emergency medicine residents on off-service rotations; radiologic imaging 1: Plain films.
Interpretation of radiologic images is an essential skill for the emergency physician. This is the first of two sets of objectives for an off-service rotation in radiology. It covers the interpretation of plain films. The second series will address commonly used, but more sophisticated, imaging modalities including the use of contrast materials, ultrasound, nuclear medicine, computed tomography, and magnetic resonance imaging. This set of objectives may be used to guide a one-month radiology rotation or serve as part of a teaching program integrated with didactic training and emergency department experience.
Curriculum↗
Objectives to direct the training of emergency medicine residents on off-service rotations; radiologic imaging 2: contrast and imaging techniques.
Interpretation of radiologic images is an essential skill for the emergency physician. This is the second of two sets of objectives for an off-service rotation in radiology. The first covered the interpretation of plain films. This series addresses commonly used imaging modalities such as contrast media, ultrasound, computed tomography, nuclear medicine, and magnetic resonance imaging. This set of objectives may be used to guide a one-month radiology rotation or to serve as part of a teaching program integrated with didactic training and emergency department experience.
Curriculum↗
Objectives to direct the training of emergency medicine residents on off-service rotations: Internal Medicine. I.
Internal Medicine is an essential but diverse field. This is the first in a three-part set of objectives for an off-service rotation in general internal medicine. This series may be used to guide the resident during the rotation or to serve as part of a teaching program integrated with didactic training and emergency department experience.
Clinical Competence↗
Objectives to direct the training of emergency medicine residents on off-service rotations: internal medicine. II.
Internal medicine is an essential but diverse field. This is the second in a three-part set of objectives for an off-service rotation in general internal medicine. This series may be used to guide the resident during the rotation or to serve as part of a teaching program integrated with didactic training and emergency department experience.
Curriculum↗
Objectives to direct the training of emergency medicine residents on off-service rotations: internal medicine III.
Internal medicine is an essential but diverse field. This is the third in a three-part set of objectives for an off-service rotation in general internal medicine for emergency medicine residents. This series may be used to guide the resident during the rotation or to serve as part of a teaching program integrated with didactic training and emergency department experience.
Emergency Medicine↗
Clinical profile and outcomes of diabetic and nondiabetic patients in cardiac rehabilitation.
BACKGROUND: Patients with diabetes mellitus have increased risk of cardiovascular disease; however, there are limited data addressing cardiac rehabilitation in these patients. This study assessed the effectiveness of participation in cardiac rehabilitation on clinical outcomes after myocardial infarction and/or revascularization procedures in diabetic and nondiabetic patients. METHODS: Analysis on 1505 patients completing a minimum of 7 weeks of a 12-week cardiac rehabilitation program included fasting lipid profile and glucose, body mass index, and metabolic equivalent time in patients with diabetes (n = 292) and without diabetes (n = 1213). RESULTS: There were significant improvements in total cholesterol, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) in each group after cardiac rehabilitation. Diabetic women and nondiabetic men had the greatest improvement in HDL-C, with an improvement of 4.9% in diabetic women (P = .02) and an improvement of 4.1% in nondiabetic men (P < or = .0001). On completion of cardiac rehabilitation, both diabetic and nondiabetic patients were at National Cholesterol Education Program Adult Treatment Panel III goals in total cholesterol, LDL-C, HDL-C, and triglycerides at a higher rate. However, patients with diabetes did not reach National Cholesterol Education Program goals for HDL-C, total cholesterol, and triglycerides as effectively as nondiabetic patients. Exercise capacity improved by 28.1% in diabetic patients after cardiac rehabilitation (P < .0001). Improvement in outcomes in the patients with diabetes occurred without significant change in body mass index. CONCLUSIONS: These results suggest that participation in a comprehensive cardiac rehabilitation program integrates care of patients with chronic conditions such as diabetes to achieve comparable cardiac risk factor reduction as achieved with nondiabetic patients.
Diabetes Complications↗
A teacher-focused approach to prevent and reduce students' aggressive behavior: the GREAT Teacher Program.
The purpose of this article is to describe the GREAT (Guiding Responsibility and Expectations for Adolescents for Today and Tomorrow) Teacher Program, a prevention program for middle school teachers to deter students' aggressive behavior. It was developed on the basis of an ecologic understanding of aggression and on specific constructs of Social Cognitive Theory. The goals of the program were (1) to increase teacher awareness of different types of aggression, risk factors, role of the classroom teacher, and influence of the school climate on the child's behavior; (2) to develop strategies that will prevent aggression; (3) to improve teacher management skills to reduce power struggles and aggression; and (4) to enhance skills to assist students who are the targets of aggression. To accomplish these goals, teachers participated in a 12-hour workshop and 10 support group sessions. Training, manuals, and supervision were provided to maintain program integrity and to assure the quality of implementation.
Adolescent↗
The problem of diagnosing major depression in elderly primary care patients.
BACKGROUND: To clarify the problem of diagnosing major depression in elderly primary care patients, we studied the nuances of diagnostic classification by general practitioners (GPs) and the relationship between sociodemographic and clinical factors and an accurate diagnosis of depression. METHODS: As part of a national survey of general practice a standardised psychiatric interview (CIDI) was performed in 237 subjects > or =55 years screened for the presence of psychopathology. Fifty-five patients were found to suffer from a major depressive disorder in the last 12 months. In these patients, GPs registered during 1 year all contact diagnoses and prescriptions of medication. RESULTS: Nearly all depressed patients (96.4%) had one or more contacts with their GP during 1 year. GPs classified 20.8% of the patients as having a down/depressed feeling or depression, while 32.1% as having other psychological problems than depression. It was remarkable that an accurate diagnosis by GPs was significantly related to higher age in this age group. Regarding the clinical characteristics, there was a significantly higher number of prescriptions of antidepressants in the accurately diagnosed patients. We found no significant differences in respect to other clinical characteristics (e.g. severity and number of symptoms, comorbidity of anxiety and somatic disorders). CONCLUSIONS: GPs are aware of the psychological problems in half of the elderly patients with major depression, but do not explicitly distinguish depressive symptoms from other psychological problems or from social problems. Integrated programs may be more promising to improve the diagnostic rate than clinical education or guideline implementation alone.
Age Factors↗
Alterations of basement membrane zone in autoimmune subepidermal bullous diseases.
BACKGROUND: Pemphigoid (BP), mucous membrane pemphigoid (MMP) and epidermolysis bullosa acquisita (EBA) are characterized by the presence of in vivo bound and circulating anti-basement membrane zone (BMZ) antibodies directed against different antigens localized in the upper part of the lamina lucida, lamina lucida-lamina densa border and in sublamina densa region, respectively. The alterations of BMZ lead to blister formation. OBJECTIVES: The aim of the present study was to compare the alterations of various regions of the BMZ in BP, MMP and EBA using laser scanning confocal microscopy (LSCM). METHODS: Biopsy specimens taken from perilesional patients' skin were cut into 40mum thick slides, followed by double immunofluorescence labeling with antibodies against different BMZ structures and anti-human IgG antibody. Three-dimensional reconstruction (3DR) of various regions of BMZ and of in vivo bound IgG was performed by computer program integrated with LSCM. RESULTS: In BP and MMP, LSCM studies revealed numerous invaginations of BMZ, most pronounced at the level of lamina lucida. Integrity of BMZ was preserved at the level of lamina lucida, lamina densa and sublamina densa. In EBA, continuity of lamina lucida was preserved and numerous invaginations were present. More pronounced invaginations of BMZ were observed at the level of lamina densa, whereas at the level of the sublamina densa region the staining along BMZ was discontinuous. Moreover, large clumps composed of collagen VII vertically oriented to the dermal-epidermal junction extending into the mid dermis were observed. CONCLUSIONS: The study showed that alterations of BMZ in BP and MMP occur mainly in the lamina lucida, and in EBA in the sublamina densa region. These alterations in various regions of BMZ in BP, MMP and EBA could be responsible for the differences in the level of blister formation and in the clinical course of the diseases.
Basement Membrane↗
Long-term effects of athletics meet on the perceived competence of individuals with intellectual disabilities.
The purpose was to examine the effects of the type of athletic program (integrated versus segregated) and of the type of sport (basketball versus swimming) on two domains of perceived competence (athletic competence and social acceptance), and general self-worth. Participants were 48 adolescent females with intellectual disabilities (ID) divided equally into six groups: (a) segregated basketball, (b) integrated basketball, (c) segregated swimming, (d) integrated swimming, (e) physical education (PE), and (f) sedentary. The experimental treatment was 21 months long; for sport groups, this involved 2h of training each week and 12 competitive meets. We administrated Harter's (Harter, S. (1985). Manual for the self-perception profile for children. Denver: University of Denver) Self-Perception Profile for Children seven times to determine changes in perceived competence, and general self-worth. Results indicated: (a) no changes in perceived social acceptance; (b) significantly lower perceived athletic competence for the integrated groups; (c) significantly lower general self-worth for the basketball groups compared to the PE group. The integrated environment helps adolescents with ID to adopt a more realistic evaluation of their physical competence.
Adolescent↗
Mathematical modeling as a tool for investigating cell cycle control networks.
Although not a traditional experimental "method," mathematical modeling can provide a powerful approach for investigating complex cell signaling networks, such as those that regulate the eukaryotic cell division cycle. We describe here one modeling approach based on expressing the rates of biochemical reactions in terms of nonlinear ordinary differential equations. We discuss the steps and challenges in assigning numerical values to model parameters and the importance of experimental testing of a mathematical model. We illustrate this approach throughout with the simple and well-characterized example of mitotic cell cycles in frog egg extracts. To facilitate new modeling efforts, we describe several publicly available modeling environments, each with a collection of integrated programs for mathematical modeling. This review is intended to justify the place of mathematical modeling as a standard method for studying molecular regulatory networks and to guide the non-expert to initiate modeling projects in order to gain a systems-level perspective for complex control systems.
Animals↗
Perioperative nursing challenges for the Russian emigré nurse.
Three San Francisco organizations participated in an integration program that focused on the design, implementation, and evaluation of a unique training project that prepared Russian émigré nurses for employment in the US health care industry. The Russian Nurse Project is a unique program that affiliates émigré nurses with specific language and cultural skills and focuses on the increasing Russian immigrant patient population. The project's implementation and diversity strategies, as they pertain to the perioperative areas of nursing practice in this country, are described.
Communication Barriers↗
Triple treat. One chapter's Project Alpha activities.
The concept of Project Alpha, a chapter-level program to promote the implementation of perioperative nursing content in nursing education programs, was introduced at the 27th annual AORN Congress in 1980. Project Alpha activities were designated as basic (ie, Project Alpha awareness, education), intermediate (ie, Project Alpha promotion, clinical preceptoring), and advanced (ie, extern program, integrated perioperative module). This article reports one chapter's success in implementing Project Alpha.
Anniversaries and Special Events↗
[Linkage to care after first hospitalisation for psychosis].
BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.
Adolescent↗
Cardiovascular disease.
The primary care physician is in a position to advise patients on the efficacy of alternative and complementary therapies as they relate to cardiovascular diseases. Anti-oxidant vitamin supplementation has not been shown to be efficacious in decreasing cardiovascular events. N-3 fatty acids appear to be beneficial in secondary prevention of cardiovascular events but their use in primary prevention is not clear. Adoption of vegetable-based diets, including whole grains, can be recommended to decrease cardiovascular events, lower cholesterol and help lower blood pressure. For patients with hypercholesterolemia, cholestin, a red-yeast rice supplement, has been shown to be effective. Garlic supplements may have some mild cholesterol-lowering effect, but this effect is not significant enough to recommend clinically. Herbal therapies with hawthorn and ubiquinone (Q10) are of possible benefit in congestive heart failure. An integrated program of rigorous diet, exercise and stress reduction in motivated patients with cardiovascular disease may have value as an alternative to cardiovascular medications and surgical interventions.
Antioxidants↗
Child sexual abuse and incest: community-based intervention.
OBJECTIVE: The primary aim of this article is to determine the effectiveness of community intervention in the case of child sexual abuse. The article describes and analyses an actual case in a small urban community in Israel. METHOD: After several incidents of child sexual abuse, much of it incestuous, were brought to light in the community, they were discussed openly, contained, and punished. A community campaign, in which community activists as well as all the service providers were involved, was organized by community social workers. Individual, group, and community interventions were used. RESULTS: The continuation of the abuse has been checked, and, so far, there is no evidence to suggest its resurgence. Community apathy to child sexual abuse seems to have been halted and reversed. The involvement of community residents, particularly the activists, has increased, and this appears to be the major factor in changed community norms toward child sexual abuse. CONCLUSION: Implications of the individual, group, and community interventions are discussed. An integrated program of intervention practices is advocated to contain and prevent the incidence of child sexual abuse and incest.
Attitude to Health↗